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CURRENT ISSUETHE JOURNAL OF CARDIOVASCULAR SURGERY

A Journal on Cardiac, Vascular and Thoracic Surgery


Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
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The Journal of Cardiovascular Surgery 2013 December;54(6):719-27

CRITICAL LIMB ISCHEMIA AND DIABETIC FOOT: AN UPDATE 

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Open surgery for chronic limb ischemia: a review

Ricco J.-B. 1, Thanh Phong L. 2, Belmonte R. 1, Schneider F. 1, Valagier A. 1, Illuminati G. 3, Regnault De La Mothe G. 1

1 Vascular Surgery Department, Jean Bernard Hospital University of Poitiers, Poitiers, France;
2 Vascular Surgery Department HochiMinh University Hospital, HochiMinh City, Vietnam;
3 The “Francesco Durante” Department of Surgery, “La Sapienza” University, Rome, Italy

This review considers the role of the different revascularization strategies in patients with chronic limb ischemia (CLI) and reveals that clinical evidence guiding therapeutic decision-making in CLI is poor and only careful basic recommendations can be made. For diffuse aortoiliac disease with occlusion of the aorta, aortobifemoral bypass remains the best option if the patient is fit for open surgery. Unilateral iliac occlusion should be treated by primary stenting, but an iliofemoral bypass may be the best option when the disease extends down to the common and deep femoral arteries. For infrainguinal revascularisation, bypass using the saphenous vein remains the best option for patients with occlusion of the superficial femoral artery >25 cm and for patients with multiple occlusions of the infrapopliteal arteries. In the absence of leg veins, arm veins should be used. Prosthetic grafts are the last option. Endovascular techniques are recommended in patients with short arterial lesions and limited life expectancy <2 years. Finally some patients with CLI are best treated by primary amputation. In conclusion, this review demonstrates that neither an endo- first nor a bypass-first attitude is appropriate in patients with CLI and suggests that these patients should be cared for by specialists in a multidisciplinary center in order to preserve their life and limbs, to conduct clinical trials and to control costs.

language: English


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